Nepal has a growing number of trained neurosurgeons, but not many have opportunity to work in public hospitals because of inadequate number of jobs in government sector. Of the 130 trained neurosurgeons in the country, more than 90% work at private hospitals, individual clinics, or individual nursing homes. Other trained Nepali neurosurgeons are mostly practicing as neurologists or neuropsychiatrist as they lack the equipment to properly practice neurosurgery. For most of the Nepali population, this has led to a situation where neurosurgery is financially out of reach, as most providers are practicing in private facilities. 

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To Dr. Witcher, the problem is clear. “There are almost 30 million Nepali people, but only a handful of neurosurgeons. They are concentrated in the large urban centers and need access to sub-specialty care and sub-specialty training. That is something we can provide for them.”

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Despite efforts to reduce health care costs in Nepal, historically out of pocket healthcare expenses push about half a million people into poverty each year (source). Out of pocket expenditure is high at 54.2%, and for non-communicable diseases such as Parkinson's 62% of costs are borne through out-of-pocket payments. Ten years ago, the National Health Insurance Program (NHIP) was introduced, but is currently ineffective due to low population coverage (28%), high dropout rates, and financial sustainability issues (source).  

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For those that cannot afford private health care, the public hospitals are the only option. The backlog is long. One neurosurgeon can perform five or six neurosurgeries per day, but the admission numbers are double to triple that capacity. Unless it’s a true emergency, most patients flock to Kathmandu for treatment. 

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Only few centers in the country have all facilities available to properly perform complex neurosurgery, including for life saving procedures, and most of these are private. Within government hospitals, treatment is provided to patients regardless of ability to pay.

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Bir Hospital in Kathmandu is one of the busiest hospitals in Nepal, and one of the only National Academy of Medical Sciences teaching hospitals. Because it is a government hospital, it has a large inflow of cases every day. Professor Rajiv Jha is the Head of its Neurosurgery Department.

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As stated by Dr. Khadka, an Assistant Professor working under Dr. Jha, “We are like a factory of cases. Whatever you visualize in a textbook you can see in one week here – we get lots of complex cases as the simple cases are dealt with outside of Kathmandu or in private centers. Ours is the pioneer center of neurosurgery, and we run operating theatres five days a week. Whenever we finish a case a new one is admitted. We don’t even have enough beds for each patient – there is a waitlist.”

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The majority of cases seen under the supervision of Professor Jha are complex cases. More than half are brain tumors, but strokes, trauma, and other surgeries are common as well. To him, training and equipment would be key to expanding what Nepalese neurosurgeons are able to offer. 

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The foundation is there. To Dr. Witcher, neurosurgery is a calling. “I do think people are called into medicine when they see suffering and want to help. I think it’s just part of who most of us are. And when you teach a neurosurgeon, you have a multiplying effect.”

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Professor Jha and Dr. Khadka were connected to the Carilion Clinic at Virginia Tech through the father of Dr. Sri Adhikari, a neurosurgery resident originally from Nepal studying under Dr. Mark Witcher. Having moved from Nepal to the United States to pursue a career in medicine, Dr. Adhikari had been looking for a way to give back. From there, the idea for the VTC Nepal Neurosurgery was born.